Gynecomastia, male chest reduction, gland excision, VASER liposuction

Many of my male patients have some form of male breast enlargement.  Not all decide to have that area treated as it does not bother them that much.  However, the patients that seek to have treatment for this particular area frequently ask about the other options available.  If they dont ask it is part of my consultation process to inform them of the other options available that are suitable.
In this day and age most patients opt for the non or minimally invasive procedures as they carry less risk and the down-time is less and recovery is faster.
In some cases though it is not appropriate to perform the non-invasive techniques and the surgical ones are more indicated.  It is then also imperative to inform the patients of the associated risks with the surgical options.  Although you may get a better result, you may also put yourself at more risk in terms of complications and side-effects.  It is thus important to balance the risk to benefit ratio.

We want exactly the opposite of what is depicted in this image.
If the wrong technique is used then the risk of adverse outcome is also higher.




The options are really 1. doing nothing 2. weight loss and losing some fat deposit in the area (if the bulk is glandular tissue then weight loss will not help at all) 3. traditional liposuction 4. VASER tumescent liposuction 5. Micro-cannula tumescent liposuction 6. surgical excision

Any of these can of course also be combined.  The most conservative is obviously 1. and 2. These may certainly not be an option if the situation is causing distress, clothing limitations and self consciousness.
Patients coming to us will have started doing some research on the various techniques available and generally come with some idea of what may be required.

3. is old style technique and usually performed under general anesthesia (completely asleep).  It has its limitations and works well if there is mainly fatty tissue and little breast gland.

4. targets the gland and the fat and can be performed under local anesthesia (only the treatment area is numbed)

5. targets the gland and the fat - suitable with smaller amounts of bulk.

6. suitable for large gland excision and  often skin excision in combination.  This is always performed under general anesthesia (completely asleep).  It comes with a variety of different risk factors and longer recovery period.

The important factor is that not too much of the tissue is removed and leaves fibrotic scar tissue that is visible when the chest muscle contracts.  This may leave you with an indented nipple or nipple that gets sucked in when you contract your chest muscles (see pictures below)

These are patients that have presented to me after surgical excision that have had too much removed.  The scar tissue attached to the underlying muscle now causes the nipple to get sucked in when contracting the chest muscles.
Hence I always leave some tissue behind which can be felt as a small disc of hard tissue just behind the nipple complex.

Seen on the left is a common male chest diagram with representation of enlargement of the gland component (right).  This may appear in  various degrees - some having more fat or some having more gland.  We obviously want to remove as much as possible, but also prevent the nipple retraction.





                                                         www.DrWolf.com

Lipoedema treatment - tumescent liposuction, VASER

I was fortunate enough to attend the Lipoedema conference on the 24th June in Reading this year.  It was well attended and very informative for networking and sharing experiences with other professionals.
It was re-iterated that not much information was available for patients with the condition and still many GP are misdiagnosing the condition as obesity.  The training course offered by Lipoedema.co.uk has however had overwhelming response from GPs in getting the word out.
Many GP are now recognizing the condition and referring patients in the right direction.
Some interesting data were produced by a German clinic on the success of tumescent liposuction including VASER and the treatment of Lipoedema.  It remains the only real way of preventing the condition from worsening especially when caught in the early stages (stage I or II).
Stage III requires more interventional treatments such as skin excision and reconstruction.
The key is to diagnose it in the early stages and manage it appropriately.  This includes MLD and wearing hosiery.

www.Lipoedema.co.uk
www.MLDuk.org.uk
http://www.lipedema-simplified.org
Henrietta@MLDLondon.co.uk